Pain and Sleeplessness Go Hand in Hand — So Should Compounded Prescriptions
Have you ever had a patient tell you she needs something for her pain so she can sleep better at night? It makes sense—the less you sleep, the less able your body is to heal on its own, which just makes the pain worse the next day. The twinned conditions of pain and insomnia can accompany a number of diseases, including arthritis, cancer, heart disease, lung disease, Parkinson’s, and Alzheimer’s. Treatments for both conditions are usually prescribed separately. However, a new study, published in the journal Pain1, suggests compounded prescriptions targeting pain and insomnia together could be key.
The study was motivated by the fact that the association between sleep and pain has not been investigated in depth. Said Dr. Børge Sivertsen, a co-author of the study, “While there is clearly a strong relationship between pain and sleep, such that insomnia increases both the likelihood and severity of clinical pain, it is not clear exactly why this is the case.” Their goal was to look at different measures of sleep, such as duration, efficiency, and the frequency and severity of insomnia, and correlate those measures with pain sensitivity tests. Data collected in over 10,000 older patients over both genders showed:
- All sleep parameters except for sleep duration were associated with reduced pain tolerance;
- Frequency and severity of insomnia, sleep onset latency, and sleep efficiency were all associated with pain; and
- There was an additive synergy between chronic pain and insomnia.
This synergistic effect of chronic pain and insomnia means that those patients feel both conditions more strongly than we thought, and are likely to suffer from other problems as well, such as:
- Higher stress;
- Decreased immune modulation; and
- Anxiety, depression, and decreased sex drive.
And that’s not even getting into the tertiary considerations of lack of will, cost of medications, and increased susceptibility to other diseases.
All of this boils down to the fact that no matter how long your patient sleeps, if the quality of that sleep is poor, and your patient doesn’t get good sleep often enough, her pain, and her quality of life, are going to get a lot worse.
How Can Compounded Prescriptions Help Our Patients?
Disrupting the negative feedback loop between pain and sleeplessness must be an early intervention. Say the authors of the study2, “As comorbid sleep problems and pain have been linked to elevated disability, the need to improve sleep among patients with chronic pain, and vice versa, is evident.”
This implies that we must treat chronic pain and insomnia before either gets too significant. Not only can we help the primary symptoms subside, but we might also lower risk factors for patients suffering from various diseases not yet in play.
How does that look practically?
- First we can compound low-level sleep aids with the meds we already provide for some diseases;
- Since the study promotes sleep over pain, we also need to educate and treat our patients relative to what they can do to sleep better; and
- We should recommend topical pain creams that avoid systemic effects which might cause sleeplessness. Ingredients that may provide pain aid include Lidocin and melatonin-based sleep aids.
We should also consider alternatives to common medications where insomnia is a common effect. For example, instead of using alpha-blockers, patients might want to consider calcium channel blockers, or possibly 5-alpha-reductase inhibitors, which disrupt sleep less. A single dosage of corticosteroids early in the day can result in less insomnia, allowing us to reduce additional sleep compounding. Or perhaps instead of using ACE inhibitors, which worsen quality of sleep, a benzothiazepine calcium channel blocker could help.
The Pain journal article is a validation of what pharmacists and patients have seen so far: that pain and insomnia go hand-in-hand. Our best approach is to ask questions about insomnia in patients suffering from chronic pain, and consider compounded prescriptions to treat both conditions. The smiles on our patients’ faces will be worth it.
New research is a key part of the service Pharmaceutica North America provides you with so you can give your patient high quality, safe medications. Please contact us today so that we may provide you with information regarding our quality compounding ingredients.